How you ask the question really matters: A randomized comparison of four questionnaire delivery modes to assess validity and reliability of self-reported socially censured data in rural Zimbabwean youth

Abstract

Validity and reliability of self-reported sexual behaviour in epidemiological surveys are suboptimal, particularly among young people. 1495 rural Zimbabwean youth were randomly allocated to one of the following: self-administered questionnaire (SAQ=373), SAQ accompanied by an audio soundtrack (Audio-SAQ=376); face-to-face interview using an informal confidential voting box (ICVI=365); and audio computer-assisted survey instrument (ACASI=381). Biomarkers for sexual activity included HIV, HSV-2 and pregnancy test in females. Key questions were selected a priori to compare item non-response and rates of reporting sensitive behaviours between questionnaire delivery modes. Additional qualitative and quantitative data were collected on method acceptability. Item non-response was significantly higher with SAQ and Audio-SAQ than with ICVI and ACASI (p<0.001). After adjusting for covariates, Audio-SAQ and ACASI users were twice as likely to report sexual activity when compared to SAQ users, with no reporting difference between ICVI and SAQ users. ACASI users reported a lower age at first sex (p<0.045). ACASI users reported increased ability to answer questions honestly (p=0.004) and believed their answers would be kept confidential. Participants claimed increased comprehension when hearing questions while reading them. ICVI users expressed difficulty answering sensitive questions, despite understanding that their answers would not be known by the interviewer. As a result, two methods, Audio-SAQ and ACASI were chosen to complete the final survey. In this larger sample we found evidence that the effect of mode differed by gender. There were fewer ACASI users with a positive biomarker for sexual activity that did not report sex (p<0.001). These results coupled with a systematic review of effect of questionnaire delivery mode on sexual behaviour reporting from developing countries provide strong evidence that ACASI significantly reduces bias, is feasible and acceptable in resource-poor settings with low computer literacy. Its increased use could improve sexual behaviour data quality.

Type:

Thesis
(Doctoral)

Title:

How you ask the question really matters: A randomized comparison of four questionnaire delivery modes to assess validity and reliability of self-reported socially censured data in rural Zimbabwean youth